Disrupting Japan podcast

AI’s new game-changing role in decoding mountains of EKGs

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The medical industry is one of the most challenging areas for startups to succeed in. "Move fast and break things" just doesn't work in medicine.  So you might be surprised to learn that right now there are quite a few innovative medical startups coming out of Japan. Today we talk with Yuichi Tamura, founder of Cardio Intelligence, who has developed Smart Robin, an AI platform that reads EKGs, has been certified as a diagnostic device, and is being used in clinics and hospitals all over Japan. We talk about the challenges of bringing medical AI to market, their plans for global expansion, and the most important thing that venture capital can offer medTech startups. It's a great conversation, and I think you'll enjoy it. Show Notes The importance and challenge of the current EKG-reading workflow Why is is so hard to bring a new medical innovations to market Yuichi's transition from medicine to business. A go-to-market strategy for medical startups How Cardio Intelligence acquired enough EKG training data Why automatic EKG diagnostic innovation stopped in the 1970s The importance of explainable AI for medical devices and diagnostics The role startups need to play in medical innovation in Japan What venture capital firms can really contribute to medTech startups (besides the capital) Links from the Founder Everything you wanted to know about Cardio Intelligence Follow them on Twitter @cardio_int Follow Yuichi on Twitter @TamCardio Transcript Welcome to Disrupting Japan. Straight Talk from Japan's most successful entrepreneurs. I'm Tim Romero and thanks for joining me. Genuinely new medical technology is one of the most difficult things for a startup to bring to market. Regulations are complex and capital needs are high, and yet Japan has a surprisingly large cluster of innovative medical startups who have new technology both approved for and actually in use in clinical practice. There are a number of reasons for this, and today we sit down with Yuichi Tamura, MD and founder of Cardio Intelligence, a startup using AI to read EKGs and detect atrial fibrillation. It's a technology that not only makes work faster, but it opens up a whole new range of important inexpensive diagnostic tests that were simply impractical before. It's AI technology that is doing genuine good. Yuichi and I dive deeply into that, and we also talk about how AI is going to change the face of telemedicine and rural hospitals. Why EKG innovation stopped in the seventies and exactly when technical founders need to step out of the CEO role. But, you know, Yuichi tells that story much better than I can. So, let's get right to the interview. Interview Tim: So, I'm sitting here with Yuichi Tamura, the founder and CEO of Cardio Intelligence and maker of Smart Robin, who's using AI to detect atrial fibrillations from EKGs. Thanks for sitting down with me today. Yuichi: Sure, my pleasure. Tim: Well, I gave a really brief introduction to what Cardio Intelligence does, and I'm sure you can explain it much better than I can. So, what do you guys do? Yuichi: So, Cardio Intelligence provides the AI medical software, which enables physicians and the technicians to lead the long-term electrocardiogram more easily. Tim: And you're focused on detecting atrial fibrillation. So, what exactly is atrial fibrillation and why is it bad? Yuichi: Atrial fibrillation is a very, very big problem for cardiac health. It brings not only heart failure, but also brain stroke because an atrial fibrillation make a paralyzing the atrium, the upper chamber in the heart, which brings some very, very small thrombin. And finally, it drives into the brain arteries which brings a brain stroke. So, in such a case, the patient suffer from very severe symptom, half of the body paralyzing and sometimes make sudden death. Tim: And from what I understand it, it's very hard to detect the risk of atrial fibrillation when someone's not having a seizure or not having an incident. Yuichi: Yeah. And some patient feel palpation with a very regular or very high beat with a heartbeat, but half of the patient does not feel anything. Tim: And so Smart Robin can read EKG output, just normal EKG output where they're not having a seizure and not feeling palpitations and predict when atrial fibrillation is likely. Yuichi: Yeah. Very important thing is, some half of the patients suffer from atrial fibrillation attack, but this kind of an attack occurs some patients suffer from once a day, some patients from the once a week, some patient once two weeks. So, it's very important to make a long term electrocardiogram to detect the atrial fibrillation attack. Tim: And is Smart Robin certified as a diagnostic device as well? Yuichi: Yes. Tim: So, tell me about your customers. Who's using Smart Robin? Is it clinics, hospitals, individual doctors? Yuichi: Yeah. Many doctors and technicians use Smart Robin to make a final diagnosis to find an atrial fibrillation. Tim: So, really briefly, let's walk through the workflow in a clinical setting. How does Smart Robin change the doctor's workflow? Yuichi: So, please remember your health check. During the health check timing, you performed an electrocardiogram, but it's covered only five to 10 seconds. So, in case the patient suffers from wrong term atrial fibrillation attack, we can capture during the very, very tiny seconds. However, half of the patients suffer from attacks by-weekly or by day. So, in such a case we cannot capture just a few seconds. So, in such a case, we put the patient the long term electrocardiogram, which called a patch type ECG, or H type ECG. But it is very, very hard burden to read in every waves more than one day, more than one week. Tim: Oh, I see. So, the patients can have a wearable EKG, generate a week, two weeks of data, and instead of a human specialist reviewing it, you can have an AI review it and say, oh, at three o'clock last Friday you had this problem. Yuichi: In these days, the physicians and the technicians by themselves manually read the electro cardio by themselves. And there is not so much confident support within software. So, it's very, very hard work. Tim: Right, and expensive work too. And so Smart Robin, it's an actual diagnostic device, it won't just say, oh, by the way, this looks interesting. It'll say, this is fibrillation. Yuichi: Yeah. From our data, the technicians usually read the 24 hours ECG in 30 minutes to one hour in general. But after taking the Smart Robin take them only three minutes. Tim: Right. I want to get back to a deep dive on both your go-to market and how it's used in a clinical setting. But before that, I want to talk a little about you. So, you graduated from KO Medical School back in 2004 and started teaching and practicing at International University of Health and Welfare. So, what made you decide to start a startup after more than a decade of teaching and practice? Yuichi: Yeah. Initially we start to make a basic techniques to make an AI diagnosis for the long term electrocardiogram and start with my friend and start with my CTO. And after successful for the manufacturing we want to make an some relationship with device companies, but it is very difficult to make new software device in the market. Tim: Why is that? Is this just the medical industry is very conservative or it's just very difficult for startups to produce these devices? Yuichi: Yeah. They do not want to make new softwares because they cannot understand their meaning for the AI devices at the time with five or six years ago. Tim: Wow. That's certainly changed, hasn't it? Everyone is talking about AI now. So, are you still teaching? Yuichi: Yes. And I make a clinical practice in the hospital. Tim: So, do you ever think you'll completely leave academia and stop practice and focus on just being a CEO? Yuichi: Yeah. Sometimes I consider with it, but it is very important to see this patient by myself and to see the clinical situation because every pain and every question always in the clinical situations. Tim: Well, I could see that from two points. I mean, one, you need to be really close to understand the needs of the doctors. But also on the sales side, I mean, doctors only listen to other doctors. Yuichi: Yeah. And I actually use a Smart Robin by myself in the hospital so I can identify the problems and goals and the target to make a Smart Robin more efficient. Tim: So, as Cardio Intelligence grows, do you see you stepping back into a more product leadership and market leadership role and hiring a full-time CEO? Yuichi: Yeah, and actually I work as a CEO to make a more good market. And because then we launched and Smart Robin for more than two years and the number of the users getting more and more, so. Tim: One of the biggest challenges that deep tech startups in Japan have is making that leadership change. It's a hard thing to do. Yuichi: Every situation is done faster for me. It's like a resident for the doctors. Tim: Yes. And very similar hours too. It's very hard workload. Yuichi: Yeah. Yeah. Tim: Well let's talk a bit about your go-to market and the future of commercializing this technology. So, the technology's proven in clinical trials. It's certified as a diagnostic device. You've got some initial use in some hospitals. What's the next step in commercialization here? Yuichi: One thing is to make a global market. In the United States, the burden of the clinical situation with an atrial fibrillation is almost the same, maybe more big problem compared with Japan. Tim: Japan. Well, I'd imagine the needs are the same everywhere. I mean, we all have the same body. Yuichi: Yeah, yeah, exactly. Tim: But are the regulations different to the certification process, are they similar? Are they really different? Yuichi: Yeah, it's similar. And we can use the same techniques.

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